Arizona Direct Deposit Form 3
Download the document to the computer for easy use
There are more pages to preview,Read on

25 S Arizona Place, Suite 111
Chandler, AZ 85225

Tel. (480) 831-2645
Toll Free: (800) 732-6986
Web: www.FirstCU.net

Direct Deposit Form
Please submit completed form to Originator’s Payroll/Accounting Dept.

Routing Number: 322172742
Direct Deposit Account Number
Deposit/Net Amount $
Personal (Receiver/Member)
Last Name

(Originator Name/Employer)
Suffix

Name

None

First Name

MI

Social Security #

Address

City

State

Zip

Arizona

Address

City

Contact Person

State

Zip

Contact Person Phone

Arizona

Home Phone

E-mail Address

Work Phone

Choose one of the following:
Start
Change
Cancel
I hereby authorize the above Originator to deduct from salaries, wages, or other dues in the amount specified above which are for
remittance to First Credit Union, 25 S. Arizona Pl. Ste. 111, Chandler, AZ 85225, for credit to my account.

___________________________________________
Signature

_______________
Date

Download Free Templates & Forms at Speedy Template http://www.SpeedyTemplate.co